Virginia Club of new york Application

If applying as a Graduate Student, please email proof of enrollment to uvanyc@uvanyc.org to proceed with your application.

Name:

Date of Birth:

Prefix:

Mr.Ms.Mrs.

Email:

Phone:

Home Address:

Business Name

Title:

Business Address:

Send Statements By:

EmailPrintBoth

School Information

Please list all colleges and universities from which you have received a degree.

School:

Degree:

Year of Graduation:

School:

Degree:

Year of Graduation:

School:

Degree:

Year of Graduation:

School:

Degree:

Year of Graduation:

School:

Degree:

Year of Graduation:

How did you hear about the Yale Club? (Please check all that apply.)

Current MemberSummer Happy HoursU.Va. Alumni MagazineWhile at VirginiaWord of MouthWebsiteWas a Previous MemberPrevious MailingSummer Student MembershipStayed OvernightProspective Member ReceptionFacebookAttended a Private EventOtherAttended a Club Event

If "Other" please specify:

Interest (Please indicate the areas of the Virginia Club that most interest you):

Please fill in your spouse/domestic partner’s information if you would like them to have signing privileges. There is a $195 annual charge plus tax (March 1 – February 28) for the signing privilege. This fee is not prorated. This signing privilege allows your spouse/domestic partner to get their own account number and use the Club without the primary member being present. Only one signing privilege account is allowed per primary account.

*Please Note: Graduate Students are not eligible for spouse/domestic partner signing privileges.

I would like signing privileges for my spouse/domestic partner. I will be responsible for all charges incurred by person authorized to sign.

Name:

Date of Birth:

Prefix:

Mr.Ms.Mrs.

Email Address:

Graduation Year:

Athletic Package Information

Sign here if you would like to add the Athletic Package to your membership. The Athletic Package is $140 quarterly ($35 for 2019 undergraduates, $70 for 2018 undergraduates, and $105 for 2017 undergrad graduates). You must opt-into the Athletic Package in order to have it. Please note the athletic package is subject to tax.

I would like to sign up for the Athletic Package:

YesNo

Signature:

Signature:

Date:

Clubhouse Membership is available to all Virginia degree holders, faculty, and full-time graduate students. Graduate students must submit verification, either a copy of one’s course schedule or most recent tuition statement, with application. PDF format is preferable.